CONGRESSIONAL STAFF REGISTRATION

Attendee Information
First Name *:
Last Name *:
Title:
Organization *:
Street Address *:
Street Address 2:
City *:
State *:
Country:
ZIP *:
Phone *:
Cell Phone:
Your Twitter Handle:
Fax:
E-Mail *:
Please make sure that this is a valid email account.
Your receipt for payment and/or the hotel acknowledgement will be sent there.
If you would like a second copy of your confirmation sent,
please enter the e-mail address here:
Preferred Name on Badge (FIRST NAME ONLY)*:
Attendee(s) has special needs *:
 Yes No
If Yes, Please Specify:
 
First Time Attendee *:
 Yes No
Name of Accompanying Spouse/Partner:
No registration fee for spouse/partner.
First AND* Last Name of Spouse/Partner:
Spouse/Partner Gender *:
 Male Female


Registration Payment Information
Registration Fees:

Late/On-Site Registration Fee
(After December 22, 2017 and On-Site):		$850


Refunds will be made for cancellations received in writing by December 22, 2017 (less a $100.00 service fee). NO REFUNDS will be made for cancellations received after December 22, 2017.


Will you be requesting a hotel room? *  

NOTE: If you select "No" a link will be included in your confirmation email that will allow you to request a room at a later time.